Tag: "EMR"

Bow-tied and charismatic, Dr. Farzad Mostashari, who led the Office of the National Coordinator of Health IT (ONC) from April 2009 to October 2013, has raised a total of $35 million from leading venture capitalists for his new business, Aledade. Aledade’s senior management includes veterans of athenaHealth and Practice Fusion, both firms which I admire for their entrepreneurship and relative (although not perfect) independence from government.

Like those firms, Aledade will provide its Electronic Health Records to independently practicing physicians. Aledade claims its uniqueness lies in an EHR that will ensure doctors’ win the Accountable Care Organization game. At NCPA, we think that ACOs are unlikely to succeed. Nevertheless, if anyone can pull this off, Dr. Mostashari and his team have got a pretty good edge (in my humble opinion).

In a hearing on Meaningful Use Stage 3, interoperability and patient access to data, Sen. Lamar Alexander (R-Tenn.) cut right to the heart of the problem.

“To put it bluntly, physicians and hospitals have said to me that they are literally terrified of the next implementation stage … because of the complexity and because of the fines that will be levied,” he said. (Katie Dvorak, FierceHealthIT, June 10, 2015)

Well, okay, but let us recall that these doctors and hospitals were happy to take the almost $30 billion of taxpayers’ money the government handed them to install the Electronic Health Records subject to these regulations

Calls for the Centers for Medicare & Medicaid Services to refrain from finalizing Meaningful Use Stage 3 are increasing, with the American Medical Association and the Medical Group Management Association adding their voices to the din.

Both organizations cite concerns over the proposed rule as it currently stands, with AMA saying in a letter to CMS Acting Administrator Andy Slavitt and National Coordinator for Health IT Karen DeSalvo that the program “will create significant challenges for physicians, patients, and vendors.”

MGMA adds in its own letter to Slavitt that Stage 3 could result in a failure to meet the goals outlined in the American Recovery and Reinvestment Act of 2009. It should be delayed, MGMA says, until it is known what the impact of Medicare Access and CHIP Reauthorization Act of 2015 will be. (Katie Dvorak, FierceEMR, June 3, 2015).

I discussed the stage 3 rule when it was published. The response of these professional groups is stunning: They were all happy to take the almost $30 billion the government handed out to induce them to install Electronic Health Records.

And they led Congress by the nose just a few weeks go to pass the flawed Medicare Access and CHIP Reauthorization Act. At the time, none of them mentioned it was going to increase the burden of EHR compliance. The first organization to explain this consequence was the NCPA, in report I wrote before the law passed. These groups are asking the government for relief from a flawed so-called Medicare “doc fix” for which they themselves had spent years lobbying.

A few years ago, this blog discussed the failure of government-dictated Electronic Health Records (EHRs) in the United Kingdom.

In Australia, the Liberal-National coalition government has decided to scrap the nation’s Electronic Health Record, blaming the previous Labour government for the current one’s failings. Unfortunately, the government plans to replace it with a new one, instead of leaving well enough alone:

The Abbott Government will deliver a rebooted personalised myHealth Record system for patients and doctors that will trial an opt-out, rather than opt-in, option as part of a $485 million budget rescue package to salvage Labor’s failed attempts to develop a national electronic medical records system.

Opt-out rather than opt-in? Doesn’t that sound kind of like a mandate? It’s an odd choice for a government that espouses free-market principles.

Arthur Allen of Politicoexposes yet another reason for doctors to fear Electronic Health Records: Their errors lead to lawsuits:

Medical errors that can be traced to the automation of the U.S. health care system are increasingly an issue in medical malpractice lawsuits.

Some of the doctors, attorneys and health IT experts involved in the litigation fear that safety and data integrity problems could undercut the benefits of electronic health records unless HHS and Congress address them aggressively.

“This is kind of like the car industry in Detroit in 1965,” says physician Michael Victoroff, a liability expert and a critic of the federal program encouraging providers to adopt EHRs. “We’re making gigantic, horrendous, unsafe machines with no seat belts, and they are selling like hot cakes.

Readers of this blog know why they are selling despite their serious flaws: The government has thrown almost $30 billion at hospitals and physicians to cause them to buy them.

New research on over half a million stroke victims admitted to hospitals from 2007 to 2010 shows that there was no difference in quality of care for those admitted to hospitals with EHRs and those without:

The new study “is a wake-up call that we should heed,” writes Dr. John Windle, chief of cardiology at University of Nebraska Medical Center, in an accompanying commentary. Windle said electronic health records haven’t been proven to improve quality of health care, the health of large groups of people, or efficiency.

“An [electronic health record’s] first priority must be support of clinical care, not documentation for billing and reimbursement,” Windle said. (Randy Dotinga, HealthDay)

This blog has long noted the painful consequences of the federal government’s intervention in health information technology (HIT). Last February, NCPA published an Issue Brief recommending that the federal government’s ambitions in HIT be rolled back. The major problem is the government’s undue influence in Electronic Health Records (EHRs).

Last month, the Administration published the regulations for stage 3 of the Meaningful Use incentives, which both pay and fine doctors for their use of EHRs in accordance with the rules. Margalit Gur-Arie describes the new rules:

Meaningful use stage 3 is adding a host of structured and codified data elements that you will need to collect and record. To that end, you should consider updating your policies as follows:

Require each patient to provide an updated resume at least once a year, because you need to continuously collect and update work history, including positions held, and financial information.

In collaboration with your attorney, create a crosswalk based on State laws and meaningful use regulations regarding what you must ask or are barred from asking your patients. For example, in some states you are not allowed to ask about guns in the domicile, and for meaningful use you must inquire how often your patient goes to church, and whether he or she is a homosexual (regardless of your specialty). It’s a fine balance, and you don’t want to break any laws.

Congressional leaders from both parties have agreed on a long-term, so-called “doc fix” that claims to solve the problem of how the federal government pays doctors who treat Medicare patients.

Currently, Congress has a certain amount of money every year to pay doctors. This amount of money increases according to a formula called the Sustainable Growth Rate (SGR), which was established in 1997. The SGR is comprised of four factors that (by the standards of federal health policy) are fairly easy to understand. Most importantly, the SGR depends on the change in real Gross Domestic Product (GDP) per capita.

The Medicare Part B program, which pays for physicians, is an explicit “pay as you go” system. Seniors pay one quarter of the costs through premiums, and taxpayers (and their children and grandchildren) pay the rest through the U.S. Treasury. Therefore, it is appropriate taxpayers’ ability to pay (as measured by real GDP per capita) be an input into the amount.

The problem is the amount is not enough. If growth in Medicare’s payments to doctors were limited by the SGR, the payments would drop by about one-fifth, and they would stop seeing Medicare patients. So, at least once a year, Congress increases the payments for a few months. The latest patch (H.R. 4302) was passed in March 2014 and runs through March 31, 2015. It costs $15.8 billion.

This has happened 17 times since 1997. Congress has never allowed Medicare’s physician fees to drop. So, why not pass a long-term fix? This would finally free politicians from having to grub around every year finding money to pay doctors, and they could turn their attention to loftier matters.

Actually, there are plenty of reasons to be skeptical of any “doc fix”, and certainly this one.

The federal government’s dominance of health information Technology (HIT) has been most apparent, and most harmful, in electronic health records (EHRs). However, the hand of government must lie heavily in other parts of health care, too.

An example is medical devices hooked up to patients at the hospital. Remarkably, these devices do not talk to each other, requiring nurses to waste time transcribing data from one device to another. This infographic summarizes a survey of 500 nurses commissioned by the West Health Institute:

Copyright: West Health Institute (2015)

These are appalling figures. I don’t know about you, but I figured out how to connect my VCR to my TV sometime during the 1980s. Medical devices are heavily regulated by the FDA. The fact that devices critical to hospital patients’ health are still not connected strikes me as a likely consequence of over-regulation.

NCPA recently released an Issue Brief questioning the federal government’s dominance of health information technology, especially electronic health records (EHRs). Our conclusion came from the failure of the federal government to bring about so-called interoperability between EHRs. Jonathan Bush, CEO of Athenahealth, a provider of EHRs, illustrates how appalling this failure has been:

The patient’s information was in an electronic medical record, or EMR. And getting the patient’s records from the hospital to the nursing home, Bush says, wasn’t exactly drag and drop.

“These two guys then type — I kid you not — the printout from the brand new EMR into their EMR, so that their fax server can fax it to the bloody nursing home,” Bush says. (Eric Whitney, NPR)

This is not because of some inexplicable factors that cause health care to lag every other industry in information technology. It is a direct consequence of government control of IT in health care.